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Posterior drooling in children with cerebral palsy and other neurodevelopmental disorders
Author(s) -
Delsing Corinne PA,
Bekkers Stijn,
Erasmus Corrie E,
van Hulst Karen,
van den Hoogen Frank JA
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14888
Subject(s) - drooling , medicine , cerebral palsy , anesthesia , surgery , botulinum toxin , cohort , physical therapy
Aim To evaluate the effect of botulinum neurotoxin A (BoNT‐A) injections, submandibular gland excision (SMGE), and bilateral submandibular duct ligation (2DL) for the control of posterior drooling in children with neurological impairment. Method In a retrospective cohort, children with neurological impairment (e.g. cerebral palsy) treated between 2000 and 2016 were identified. Mean age at time of surgery was 9 years (range 1–21y). The primary outcome was posterior drooling severity by a visual analogue scale (VAS; 0–10) at baseline, 8‐weeks, and 32‐weeks follow‐up. The secondary outcome was lower respiratory tract infections during the follow‐up period. Results Ninety‐two patients (out of 475; 47 males, 45 females) were identified. They were undergoing three different treatments: BoNT‐A ( n =63), SMGE ( n =16), and 2DL ( n =13). A significant reduction in VAS over time was observed in the total group of 92 patients. After SMGE, VAS decreased significantly from 6.82 (SD 3.40) at baseline to 2.29 (SD 1.93) at 8 weeks, and 2.17 (SD 2.58) at 32 weeks ( F [2.34]=11.618, p <0.001). There was no significant decrease after both BoNT‐A and 2‐DL. Interpretation Posterior drooling is an unfamiliar, potentially life‐threatening condition that is treatable with medication, BoNT‐A injections, or surgery. Although all treatments reduced signs and symptoms of posterior drooling, there is a greater effect after SMGE compared to BoNT‐A and 2‐DL.What this paper adds Submandibular gland excision has better results for posterior drooling than botulinum toxin A or submandibular duct ligation.